Heart failure: epidemiology, pathophysiology and diagnosis
Roy Gardner
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Abstract
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Heart failure is a complex clinical syndrome resulting from impaired cardiac pump function, leading to symptoms such as breathlessness and fatigue. Its multifactorial pathophysiology includes structural and electrical abnormalities of the heart, along with systemic processes affecting other organs. Effective diagnosis relies on comprehensive investigations to uncover underlying causes, evaluate cardiac function, and assess comorbidities, guiding appropriate treatment strategies.
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Pathophysiology of Heart Failure
Developments in cardiovascular medicine, 1996
Heart failure syndrome is defined as the inability of the heart to deliver adequate blood to the body to meet end-organ metabolic needs and oxygenation at rest or during mild exercise. Myocardial dysfunction can be defined as systolic and/or diastolic, acute or chronic, compensated or uncompensated, or uni-or biventricular. Several counterregulatory mechanisms are activated depending on the duration of the heart failure. Neurohormonal reflexes such as sympathetic adrenergic system, renin-angiotensin cascade, and renal and peripheral alterations attempt to restore both cardiac output and end-tissue perfusion. An adequate stroke volume cannot be ejected from the left ventricle, which shifts the whole pressure-volume relationship to the right (systolic failure). Adequate filling cannot be realized due to diastolic stiffness, which shifts the diastolic pressure-volume curve upward without affecting the systolic pressure-volume curve (diastolic failure). Left ventricular heart failure is the dominant picture of heart failure syndrome, but the right heart can develop isolated failure as well. Biventricular failure is mostly an end-stage clinical situation of the heart failure syndrome. More recently, the rise in the incidence of right ventricular failure can be seen after the implantation of a left ventricular assist device. This chapter clarifies and presents pathophysiologic alterations in heart failure syndrome.
Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure
European Journal of Heart Failure, 2021
In this document, we propose a universal definition of heart failure (HF) as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. We also propose revised stages of HF as: At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41-49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%.
Pathophysiology in Heart Failure
Cardiomyopathies - Types and Treatments, 2017
Heart failure syndrome is defined as the inability of the heart to deliver adequate blood to the body to meet end-organ metabolic needs and oxygenation at rest or during mild exercise. Myocardial dysfunction can be defined as systolic and/or diastolic, acute or chronic, compensated or uncompensated, or uni-or biventricular. Several counterregulatory mechanisms are activated depending on the duration of the heart failure. Neurohormonal reflexes such as sympathetic adrenergic system, renin-angiotensin cascade, and renal and peripheral alterations attempt to restore both cardiac output and end-tissue perfusion. An adequate stroke volume cannot be ejected from the left ventricle, which shifts the whole pressure-volume relationship to the right (systolic failure). Adequate filling cannot be realized due to diastolic stiffness, which shifts the diastolic pressure-volume curve upward without affecting the systolic pressure-volume curve (diastolic failure). Left ventricular heart failure is the dominant picture of heart failure syndrome, but the right heart can develop isolated failure as well. Biventricular failure is mostly an end-stage clinical situation of the heart failure syndrome. More recently, the rise in the incidence of right ventricular failure can be seen after the implantation of a left ventricular assist device. This chapter clarifies and presents pathophysiologic alterations in heart failure syndrome.
Heart failure: Clinical manifestations, Etiology, Risk factors, Diagnosis and Treatment in adults
International Journal of Medical Sciences and Nursing Research , 2023
Background: Heart failure, a complex cardiac condition, arises when the heart's ability to pump blood diminishes, leading to insufficient oxygen and nutrients delivery to the body's organs and tissues. In this paper, we discussed about heart failure disease, its symptoms, etiology and risk factors, epidemiology, pathophysiology, diagnosis, and treatment. Methods: I have to discuss about heart failure disease, its symptoms, etiology and risk factors, epidemiology, pathophysiology, diagnosis, and treatment. Results: Heart failure, often a late-stage consequence of various processes, especially ischemic heart disease, carries a poor prognosis, with mortality rates similar to common cancers. Diagnosis relies on history and physical assessment, while imaging and lab findings assist in confirmation. The New York Heart Association classification may be employed. Conclusion: Heart failure is a severe condition where the heart can't pump blood effectively due to causes like coronary artery disease or hypertension. Treatment includes lifestyle changes, meds, and surgery. Early diagnosis and treatment are essential for improving quality of life.
Universal Definition and Classification of Heart Failure
Journal of Cardiac Failure, 2021
In this document, we propose a universal definition of heart failure (HF) as the following: HF is a clinical syndrome with symptoms and or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and or objective evidence of pulmonary or systemic congestion. We propose revised stages of HF as follows. At-risk for HF (Stage A), for patients at risk for HF but without current or prior symptoms or signs of HF and without structural or biomarkers evidence of heart disease. Pre-HF (stage B), for patients without current or prior symptoms or signs of HF, but evidence of structural heart disease or abnormal cardiac function, or elevated natriuretic peptide levels. HF (Stage C), for patients with current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality. Advanced HF (Stage D), for patients with severe symptoms and/or signs of HF at rest, recurrent hospitalizations despite guideline-directed management and therapy (GDMT), refractory or intolerant to GDMT, requiring advanced therapies such as consideration for transplant, mechanical circulatory support, or palliative care. Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). The classification includes HF with reduced EF (HFrEF):
Heart failure: epidemiology, investigation and management
Medicine, 2010
Heart failure (HF) is a clinical syndrome characterized by dyspnoea, fatigue and fluid retention accompanied by objective evidence of cardiac dysfunction. The syndrome affects around 2% of the general population, affecting men more commonly than women (under the age of 80), with incidence and prevalence rising steeply with age. HF causes substantial morbidity and reduced life expectancy, and coronary artery disease accounts for two-thirds of cases in developed countries. Investigation is important to ascertain the diagnosis, identify the aetiology (which might be reversible) and give some indication of prognosis. Currently, more than 40% of people die within 18 months of a new diagnosis of HF. Treatment has been revolutionized by large randomized-controlled clinical trials studying the effects of antagonism of the renineangiotensinealdosterone and sympathetic nervous systems, and, more recently, the effects of device therapy. Cardiac transplantation remains an option for patients who are severely symptomatic (and at high risk) despite optimal medical and appropriate device therapy.
Medical conditions regarding heart failure
ACTA Medica Transilvanica
The increased incidence of cardiovascular diseases among adults causes interests in the study of pathologies of this functional system. In this context, it is envisaged that cardiovascular diseases, in addition to the clinical aspect, draw attention from a medical standpoint to the involvement of other organs belonging to other apparatus and systems. From this perspective, this study highlights the imagistic and structural aspects of cardiovascular disease and structural aspects of the disease prior to its installation, focusing on the organs involved with cardiovascular diseases. This study refers specifically to the conventional imagistic features that suggest heart failure and its evolution with possible decompensation. In order to extend this study, references to the normal structural aspects were made, regarding the organs and systems involved in the pathology of previously mentioned pathology, with their integrity before the onset of the disease.
Heart failure overview
Heart Failure Reviews, 2006
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Important Aspects of the Treatment of Chronic Heart Failure
CENTRAL ASIAN JOURNAL OF THEORETICAL & APPLIED SCIENCES, 2022
Relevance of the topic. Chronic HF is a disease with a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.) associated with inadequate perfusion of organs and tissues at rest or during exercise and often with fluid retention in the body. Decompensation of CHF often leads to death, which becomes a socio-economic problem for the state. The problem of preventing decompensation and creating the basis for a stable course of CHF is one of the main tasks of the cardiological medical community [4].Although there have been many advances and achievements in medicine in the treatment of cardiovascular diseases, the prevalence of CHF is steadily increasing, ranging from 1.5 to 2.0% in the general population, and among people over 65 years of age it reaches 6-17%. Among the causes of disability and mortality of the population, CHF occupies a high level. More than 70% of men and 63% of women with CHF die within 6 years after the first clinical manifestations of the disease. According to some researchers, CHF will become the main problem of cardiology that society will have to face in the next 50 years [1, 7].CHF is a pathophysiological syndrome in which, as a result of one or another disease of the cardiovascular system or under the influence of other etiological causes, there is a violation of the ability of the heart to fill or empty, accompanied by an imbalance of neurohumoral systems (RAAS, sympatho-adrenal system, natriuretic peptide system, kinin -kallikrein system) with the development of vasoconstriction and fluid retention, which leads to further dysfunction of the heart (remodeling) and other target organs (proliferation), as well as to a mismatch between the provision of organs and tissues of the body with blood and oxygen with their metabolic needs.
A beat too short a narrative review of heart failure
Background: Heart failure (HF) is one of the most common global public health concerns and a leading cause of death with the steadily increasing prevalence and substantial impact on quality of life. The objective of the article is to analyze various components of HF and discuss its determinants.
An alternative approach to understanding the pathophysiological mechanisms of chronic heart failure
International Journal of Cardiology, 2012
Heart failure in real world
Italian Journal of Medicine, 2013
The heart failure (HF) is one of the greatest problems of public health with increasing epidemiological importance. In the present study we analyzed a population of 299 patients, consecutively admitted to hospital, whose diagnosis of HF was verified retrospectively. In our analysis we considered underlying heart diseases, comorbidities, ejection fraction, presence of atrial fibrillation and pleural effusion, values of NT pro-BNP and causes of destabilization precipitating HF. The mean age of our population was 81 years. Patients with preserved systolic function were 145 (61% of the total, 59 male and 86 female). 166 patients (69% of the total) had hypertensive heart disease and 211 had hypertension (88% of the total). Patients with pleural effusion were 108 (46% of total). In the total population 102 patients (43%) had from 3 to 5 comorbidities, 169 patients (71%) had at least 2 comorbidities and only 4 patients (1.7%) had no comorbidities. The collected data highlight the complexit...
Heart failure: pathophysiology, risk assessment, community management and anaesthesia
Continuing Education in Anaesthesia Critical Care & Pain, 2008
The treatment of heart failure: The Task Force of the Working Group on Heart Failure of the European Society of Cardiology
European Heart Journal, 1997
Diagnosis of heart failure-the link to management The proper diagnosis of heart failure has several prerequisites. These are the correct recognition of the presence of heart failure, the assessment of the physiological abnormalities, the underlying aetiology, the detection of concomitant diseases which may interfere with its management, and the estimation of the severity. The European Guidelines for the Diagnosis of Heart Failure' 11 concluded with a management outline (Table 1).
Heart Failure - new insights
The Israel Medical Association Journal Imaj, 2009
Heart failure: role and point of view of cardiac intensivist
Cardiovascular diagnosis and therapy, 2021
Heart failure is an acute or chronic syndrome where the heart is unable to provide adequate amount of oxygen to body tissues. The treatment of heart failure aims to give an immediate answer in terms of regression of volume overload and restoration of hemodynamic stability and then to ensure management of clinical exacerbation, reduction in hospital stay, and increasing of survival. The pharmacological treatment of heart failure includes drugs with different strength of evidence. When the patient is no more responsive to medical therapy a non-pharmacological approach may be required. The first step is cardiac resynchronization therapy and implantable cardiac defibrillator. Then hospitalization and inotropic support may be needed. When cardiac disease reaches the end stage, the severe decrease in multi organ perfusion requires a quick therapeutic response. This is a time dependent scenario, when mechanical circulatory support (MCS) plays a crucial role. MCS may be used as temporary he...
Pathophysiology and Management Chronic Heart Failure
South Asian research journal of biology and applied biosciences, 2022
Chronic heart failure refers to a clinical state of systemic and pulmonary congestion resulting from inability of the heart to pump as much blood as required for the adequate metabolism of the body. The commonest causes of heart failure are coronary artery disease, hypertension and diabetes, however, hypertension and diabetes have been found to be stronger risk factors in elderly women and coronary artery disease and smoking are stronger risk factors in elderly men. Pathophysiologically, heart failure is either an inadequate cardiac output for the organism's metabolic demands or an adequate cardiac output that is due to neurohormonal compensation, which means the inability of the heart to supply blood to the tissues according to their needs without additional strain. The pharmacological treatment of chronic heart failure with reduced ejection fraction is now based on four classes of drugs that have been proven to reduce mortality among heart failure patients such as angiotensinogen converting enzyme inhibitors or angiotensin II receptor blockers, beta-blockers, aldosterone antagonists and sodium-glucose co-transporter 2 inhibitors. Angiotensinogen converting enzyme inhibitors or angiotensin II receptor blocker therapy should be initiated at a low dose with very gradual up titration, monitoring renal function and serum potassium levels closely. Chronic heart failure treatment with direct inhibitors of aldosterone receptors brought about a significant improvement in terms of survival and hospitalizations.
Introductory Editorial - Heart Failure: An Exploration of Recent Advances in Research and Treatment (A)
Clinical Medicine Insights: Cardiology, 2015
Supplement Aims and Scope Systematic reviews § § Observational studies § § Commentary on clinical trials § § Risk and safety of medical interventions § § Epidemiology and statistical methods § § Evidence-based medicine § § Evaluation of guidelines § § Translational medicine § § Article types include original clinical and basic research articles, case reports, commentaries, meeting reports, methodology, perspective, research proposal, reviews, software/database reviews, and technical advance.
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